| NPI | 1245559665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NE 26508) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 26508) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2023-08-04 |